It's an unusual time to be graduating from medical school. My first year rang in inaugural enrollments of the Affordable Care Act (ACA), also known as Obamacare. I remember celebrating with fake champagne glasses filled with apple juice when one of my patients received the results of her now-covered mammogram. She was cancer-free. With her extensive family history of breast cancer and years of anxiety waiting to afford the expense, the mammogram alone was a victory; the normal result was icing.
Since the ACA was implemented and guaranteed Americans access to core health services — including comprehensive women's health — learning medicine has been hopeful. I can offer a woman preventative services knowing she'll be able to access them. With the future of the ACA in question, I worry that women's health is in jeopardy.
The ACA ensures several important protections for women's health currently facing repeal. First, under the essential health benefits provision, all insurers must cover core women's preventative health services including breast and cervical cancer screening, sexually transmitted infection testing, domestic violence counseling, and contraception. Since the ACA, over 47 million women obtained access to health services that were previously denied or offered at extremely high co-pays. Before the ACA, contraception made up to 30 percent of women's out-of-pocket health care expenses. Now, women can access a variety of contraceptive options including highly effective long-acting contraception at significantly reduced costs, which improves access and choice for reproductive health.
Another important component of the ACA is the inclusion of maternity care as an essential health benefit. According to the national Medical Expenditure Panel Survey, the cost of the average uncomplicated delivery in 2011 was $20,000, an expense that burdened families and debilitated single mothers. With the ACA's mandated maternity coverage, any woman should be able to access quality prenatal and delivery health care resulting in healthier babies and healthier moms. Thanks to the ACA, health insurance plans are required to cover breastfeeding services such as breast pumps to assist nursing mothers. Breastfeeding prevents certain cancers in women and infections in infants. Supporting breastfeeding is one simple way to improve both maternal and child health. Early data from a census-based study on the impact of the ACA on breastfeeding suggests 47,000 more infants started on breast milk in 2014 compared to pre-ACA years. Progress in maternal health looks promising if the ACA remains intact.
The third and arguably most important benefit of the ACA for women's health is that it explicitly prohibits discrimination of health care coverage based on sex. In 2012, before the ACA, a 25-year-old woman might pay up to 81 percent more for health insurance than a man. Before the ACA, common health events in a woman's life including pregnancy and breast cancer were considered pre-existing conditions that excluded women from enrolling in insurance policies. Without the legal protection of the ACA to prevent discriminatory practices among insurers, I worry for the health of women and all persons with a uterus or breasts.
This is why, as an aspiring family physician planning to work with women from their first to their last period, I firmly oppose a repeal of the ACA without a viable replacement that guarantees the full spectrum of women's health services currently protected. After graduating from medical school this spring, I hope to begin a career in which no woman must choose between a pap smear and a car payment. Our health care system cannot go back to the days where it created such uncertainty and anxiety for women wondering if their health concerns both common and significant are going to be covered. We must defend the progress we've made by improving — not repealing — the ACA for the future of our profession, but mostly for the future of our patients. If you, too, are concerned about the repeal of the ACA and women's health, contact Sen. Michael Bennet by calling 303-455-7600 or leave a message at bennet.senate.gov. Tell him the ACA must stay.
Jennifer Sneden is a Denver native and Colorado State University alumna studying medicine at the University of California, San Francisco.